Media coverage of the Stupak amendment underestimates its impact on privately-funded abortion. The impact is also being downplayed by the right.
This looks specifically at the language of the amendment to show how it:
1. Certainly eliminates the ability of any health insurance plan participating in the new health insurance exchange from covering abortions for any enrollee, if the plan accepts any enrollee who uses federal funds to pay any part of the premium. This would include the public option, but also any other plans that participate in the exchange.
It also prohibits any plan that would offer “affordability credits” from covering abortions.
2. Could eliminate current practices by 17 states to cover abortion under Medicaid, and prevent other states from doing so.
In addition, it has the following potential effects:
3. Can eliminate the ability of any health insurance plan covered by any part of HR 3962 to cover abortion, depending on the menaning of "any costs."
This could mean any health insurance plan offered through the new health insurance exchanges. The Exchanges, in turn, include both private insurance plans, and a public option.
4. Can eliminate all health insurance funding for abortion, depending on the meaning of "authorizes."
1. Certainly eliminates the ability of any health insurance plan participating in the new health insurance exchange from covering abortions for all enrollees, if the plan accepts any enrollee who uses federal funds to pay any part of the premium. In this way it restricts abortion coverage both to low-income and middle-income women who receive federal funds for subsidies. It also restricts coverage for women who pay entirely with their own funds. This would include the public option, but also any other plans that participate in the exchange.
There is general agreement that the amendment prevents health plans in the new health insurance exchanges from covering abortions, if they will accept women who use federal subsidies to pay part of their premiums.
This prohibition applies to all plans in the exchange. These include the public option, as well as all other private insurance plans in the exchange.
Some people (those earning up to 400% of the federal poverty limit, or about $88,000 for a family of 4) will use federal subsidies (or “affordability credits”) to pay for their premiums. Those people could not buy a health plan that covers abortion through the exchange.
It will apply even though the federal subsidies constitute only a part of the premium, and the rest is paid through private funds.
In addition, any plan that intends to enroll people who accept federal subsidies to help pay part of their premiums will not be able to cover abortion, for anyone who enrolls in the plan. This means women who do not accept federal subsidies, who pay the entire cost of insurance privately, cannot buy an insurance plan that covers abortion through the exchange, if the same health insurance plan covers women who do use the subsidies.
The bill offers women the ludicrous option of buying supplemental abortion plans, as long as they do so outside of the exchange and using their own money. Supplemental abortion plans cannot be purchased using affordability credits, which are public funds. This extra punch assures that in case the Supreme Court balks at outlawing abortion outright for millions of women with employer-provided insurance, women earning up to 400% of the poverty level who take advantage of public subsidies won't be able to use their insurance when they find out their birth control has failed.
All of this is worse than current law. Current law, through the Hyde amendment of 1976, says no federal funds can be used for abortion except if the mother’s life is in danger or in the case of rape or incest. Where the language is ambiguous, the Supreme Court will decide.
"Sec. 265. LIMITATION ON ABORTION FUNDING.
(a) IN GENERAL.- No funds authorized or appropriated by this Act (or an amendment made by this Act) may be used to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion, except in the case where a woman suffers from [life-threatening illness related to the pregnancy, or pregnancy is a result of rape or incest]."
2. Could eliminate current practices by 17 states to cover abortion under Medicaid.
17 states now find ways to use state funds to pay for abortion through Medicaid. Medicaid is a program for low-income women which is funded jointly by state and federal dollars. The amendment appears to explicitly prohibit this:
"(b) OPTION TO PURCHASE SEPARATE SUPPLEMENTAL COVERAGE OR PLAN. – Nothing in this section shall be construed as prohibiting any nonfederal entity (including an individual or State or local government) from purchasing separate supplemental coverage for abortions for which funding is prohibited under this section, or a plan that includes such abortions, so long as –
(2) such coverage or plan is not purchased using –
(B) other nonfederal funds required to receive a federal payment, including a State’s or locality’s contribution of Medicaid matching funds."
3. Could eliminate the ability of any health insurance plan covered by any part of HR 3962 to cover abortion, whether or not it includes people who use federal subsidies to pay for their premiums, depending on the menaning of "any costs."
This explicitly could mean any health insurance plan offered through the new health insurance exchanges, both private insurance plans, and the public option.
The amendment says “No funds authorized or appropriated by this act…may be used to …cover any part of the costs of any health plan that includes coverage of abortion.”
It also does not restrict the use of federal funds to premiums. “Any part of the costs of any health plan” could refer to the administrative costs of setting up a health insurance exchange.
There will be people covered in the Exchanges who do not receive any federal subsidies for their premiums. They will pay every penny of the premium out of their own pockets. Some others will pay the premium by a combination of funds from their employers and from themselves.
These people may not be able to buy a plan through the Exchange that covers abortion
4. Can eliminate all health insurance funding for abortion, depending on the meaning of "authorizes."
It says that no funds "authorized or appropriated" by HR 3962 can be used to pay for abortion or to cover the costs of any health plan that covers abortion. It does not limit the application of this prohibition to funds authorized by any section of the bill, to health insurance exchanges, or to the public option. It applies to every word in HR 3962.
It also doesn’t necessarily restrict its application to funds “authorized” by Congress to be paid through federal sources.
Authorization and appropriation are particular acts by Congress to direct public funds to various purposes. That could be what this language means. Which would be bad enough.
The bill also "authorizes" employers and individuals to contribute to health insurance. These are private funds. The funds can be used to buy health insurance entirely privately. Or they could be used to buy insurance within the new health insurance exchanges. It could mean that no health insurance plan purchased as a result of the bill can be used to pay for abortion. None. It is possible that no health plan that covers abortion could be offered through programs created by this bill.
In the case of ambiguity, the Supreme Court could make the final decision.
Thursday, November 12, 2009
Monday, November 9, 2009
Enough
I think that HR 3962 offers many important improvements over the status quo, in the areas of coverage, affordability and quality, despite significant limitations, I will document these shortly.
The Stupak amendment however is exactly the poison pill it is meant to be. It virtually rolls back women's current legal right to choose abortion. It is an unacceptable political compromise. It cannot stand. Read it here:
http://www.centerforpolicyanalysis.org/id58.html
It says that no funds "authorized or appropriated" by HR 3962 can be used to pay for abortion or to cover the costs of any health plan that covers abortion.
Authorization and appropriation are particular acts by Congress to direct public funds to various purposes. That could be what this language means. Which would be bad enough.
The bill also "authorizes" employers and individuals to contribute to health insurance. These are private funds. It could mean that no health insurance plan purchased under the auspices of the bill can be used to pay for abortion. None. It is possible that no health plan that covers abortion could be offered through programs created by this bill. This may be a debatable interpretation. If it is challenged, the Supreme Court will decide.
It adds that supplemental abortion plans cannot be purchased using affordability credits, which are public funds. This is an extra punch to be sure that just in case the Supreme Court balks at outlawing abortion outright for millions of women with employer-provided insurance, women earning up to 400% of the poverty level who take advantage of public subsidies won't be able to use their insurance once they find out their birth control has failed.
Why are we facing this devil's bargain at the 11th hour in this campaign? Where was the vigorous organizing and mobilization campaign to get the votes needed to pass this bill without dismantling women's hard-fought rights? Was it news to anyone that the Catholic bishops oppose abortion, that they have access to an energized constituency, or that this constituency represents a minority of opinion even among Catholics?
This is not a re-election pitch or a solicitation for funds, which usually prompts messages like these from our leaders. It is also not a proposal for a particular action, People will need to figure out together what to do about this.
Planned Parenthood to their credit suggests writing to the President, calling this the outrage that it is and calling for actual leadership. Good start.
The Stupak amendment however is exactly the poison pill it is meant to be. It virtually rolls back women's current legal right to choose abortion. It is an unacceptable political compromise. It cannot stand. Read it here:
http://www.centerforpolicyanalysis.org/id58.html
It says that no funds "authorized or appropriated" by HR 3962 can be used to pay for abortion or to cover the costs of any health plan that covers abortion.
Authorization and appropriation are particular acts by Congress to direct public funds to various purposes. That could be what this language means. Which would be bad enough.
The bill also "authorizes" employers and individuals to contribute to health insurance. These are private funds. It could mean that no health insurance plan purchased under the auspices of the bill can be used to pay for abortion. None. It is possible that no health plan that covers abortion could be offered through programs created by this bill. This may be a debatable interpretation. If it is challenged, the Supreme Court will decide.
It adds that supplemental abortion plans cannot be purchased using affordability credits, which are public funds. This is an extra punch to be sure that just in case the Supreme Court balks at outlawing abortion outright for millions of women with employer-provided insurance, women earning up to 400% of the poverty level who take advantage of public subsidies won't be able to use their insurance once they find out their birth control has failed.
Why are we facing this devil's bargain at the 11th hour in this campaign? Where was the vigorous organizing and mobilization campaign to get the votes needed to pass this bill without dismantling women's hard-fought rights? Was it news to anyone that the Catholic bishops oppose abortion, that they have access to an energized constituency, or that this constituency represents a minority of opinion even among Catholics?
This is not a re-election pitch or a solicitation for funds, which usually prompts messages like these from our leaders. It is also not a proposal for a particular action, People will need to figure out together what to do about this.
Planned Parenthood to their credit suggests writing to the President, calling this the outrage that it is and calling for actual leadership. Good start.
Sunday, November 1, 2009
Is 2% Worth It?
Now we’re hearing that the public option is too puny to work. Is it true?
Let’s back up a minute, and look at the choices before us right now.
1. No change.
2. A reform bill with no public option.
3. A reform bill with a public option.
The insurance industry thinks #1 and #2 are just grand. (Despite what they say in public.) They’d like us to believe that #3 is so useless that we should settle for #1 or #2. Here’s why they are wrong:
The existence of a public option creates a wedge for the public sector. The public sector already covers people who are over 65, low-income, in the military, and others. Now it will start slicing into working age Americans. It will have the most bargaining clout to pay lower rates to providers – drug companies, hospitals and doctors - if it includes most of us right away, and can base reimbursement rates on Medicare, plus 5% for wiggle room.
Nancy Pelosi tried to get that. She came up short of the 218 votes needed. After a week of “whipping,” she proposed 2nd best: a public option that will negotiate rates with providers. It won’t save as much money as “Medicare plus 5%” version. Not a great performance by our elected members of Congress, who could’ve sided with the voters who use health care services instead of the industries that provide health care, or by the President of Change, who kept his elegant neck tucked in on that subject.
The Congressional Budget Office and Joint Tax Committee did some pretty quick math:
“By 2019, CBO and JCT estimate, the number of nonelderly people who are
uninsured would be reduced by about 36 million, leaving about 18 million
nonelderly residents uninsured (about one-third of whom would be
unauthorized immigrants). Under H.R. 3962, the share of legal nonelderly
residents with insurance coverage would rise from about 83 percent
currently to about 96 percent. Roughly 21 million people would purchase
their own coverage through the new insurance exchanges, and there would
be roughly 15 million more enrollees in Medicaid than the total number
projected for Medicaid and CHIP combined under current law. (Under the
bill, CHIP would no longer exist in 2019.) Relative to currently projected
levels, the number of people purchasing individual coverage outside of the
exchanges would decrease by about 6 million, and the number obtaining
coverage through employers would increase by about 6 million.
“Under the proposal, certain employers could allow all of their workers to
choose among the plans available in the exchanges, but those enrollees
would not be eligible to receive subsidies via the exchanges (and thus are
shown in Table 2 as enrollees in employment-based coverage rather than as
exchange enrollees). CBO and JCT expect that approximately 9 million
people would obtain coverage in that way in 2019, bringing the total
number of people enrolled in exchange plans to about 30 million in that
year. Roughly one-fifth of the people purchasing coverage through the
exchanges would enroll in the public plan, meaning that total enrollment in
that plan would be about 6 million.
“That estimate of enrollment reflects CBO’s assessment that a public plan
paying negotiated rates would attract a broad network of providers but
would typically have premiums that are somewhat higher than the average
premiums for the private plans in the exchanges. The rates the public plan
pays to providers would, on average, probably be comparable to the rates
paid by private insurers participating in the exchanges. The public plan
would have lower administrative costs than those private plans but would
probably engage in less management of utilization by its enrollees and
attract a less healthy pool of enrollees. (The effects of that “adverse
selection” on the public plan’s premiums would be only partially offset by
the “risk adjustment” procedures that would apply to all plans operating in
the exchanges.)”
This is a possible scenario. CBO and JCT are about as smart as anyone, and we need a guidepost in all this, Lord knows. But honestly. We know for sure the public plan will have lower administrative costs and no profits. Will it engage in less utilization management (read, frivolous denial of claims) compared to private insurance plans? We hope so – and we damn well plan to stop the insurance industry from that deadly business plan, too. Will it enroll fewer people, therefore be more expensive, therefore enroll sicker people, therefore be more expensive and enroll fewer people, etc.? Beats me.
Here’s what I’m pretty sure about. I don’t like Options #1 and #2. The public doesn’t either.
I think Option #3 gets us to the next step: coming out of this battle with a victory, and going back to the states to fight for single payer.
Some on the left meet up with the right on this point: they prefer Options #1 and #2. They say the House bill (Option #3) gives more money and power to the insurance industry than they have now. True. But so do Options #1 and #2. In fact, the only way the insurance industry gets less money is to get rid of them. A single payer program funded entirely by the government would accomplish this. We haven’t won the public’s support for that yet, and it’s not just because Max Baucus wouldn’t hold hearings on it.
A bill with Option #3 gives more power to the public sector, and arguably will save some money. It includes the following important benefits for people:
For the first time, most employers will have to contribute to the cost of health insurance. We’re the only system in the world that relies primarily on the workplace to get insurance, but we also have no requirement on employers to actually offer insurance or help pay for it. Right now about 130 million people get insurance through work, but another 27 million workers do not.
It requires individuals to buy insurance, but it provides subsidies to low- and middle-income individuals and families, so they can afford it. Is it affordable enough? Probably something to fight about.
Insurance company abuses will be prohibited: They won’t be able to exclude people with pre-existing conditions, or stop paying for your treatment once it turns out your sick. They’ll have to spend 85% of our premium dollars on actual health care, not executive bonuses and administration.
Costs: gives the government the authority to negotiate for drug prices.
Access: Many more people will qualify for Medicaid, the federal-state program for low-income people. The feds pick up most of the tab. People with COBRA can keep it until the new exchanges kick in, in 2013, and young people can stay on their parents’ plans til age 27. We still need it to start sooner.
Quality: Reform Medicare to encourage better quality of care, eliminate copayments for preventive care, and increase the number of primary care providers.
Is any old thing ok then? I think the victories so far on the public plan are important. We have to fight hard to keep it and strengthen it on the House side, and make sure it gets into the Senate bill in conference. And let’s hold on to each others’ email addresses. We’ll need them for the state single payer fights.
Let’s back up a minute, and look at the choices before us right now.
1. No change.
2. A reform bill with no public option.
3. A reform bill with a public option.
The insurance industry thinks #1 and #2 are just grand. (Despite what they say in public.) They’d like us to believe that #3 is so useless that we should settle for #1 or #2. Here’s why they are wrong:
The existence of a public option creates a wedge for the public sector. The public sector already covers people who are over 65, low-income, in the military, and others. Now it will start slicing into working age Americans. It will have the most bargaining clout to pay lower rates to providers – drug companies, hospitals and doctors - if it includes most of us right away, and can base reimbursement rates on Medicare, plus 5% for wiggle room.
Nancy Pelosi tried to get that. She came up short of the 218 votes needed. After a week of “whipping,” she proposed 2nd best: a public option that will negotiate rates with providers. It won’t save as much money as “Medicare plus 5%” version. Not a great performance by our elected members of Congress, who could’ve sided with the voters who use health care services instead of the industries that provide health care, or by the President of Change, who kept his elegant neck tucked in on that subject.
The Congressional Budget Office and Joint Tax Committee did some pretty quick math:
“By 2019, CBO and JCT estimate, the number of nonelderly people who are
uninsured would be reduced by about 36 million, leaving about 18 million
nonelderly residents uninsured (about one-third of whom would be
unauthorized immigrants). Under H.R. 3962, the share of legal nonelderly
residents with insurance coverage would rise from about 83 percent
currently to about 96 percent. Roughly 21 million people would purchase
their own coverage through the new insurance exchanges, and there would
be roughly 15 million more enrollees in Medicaid than the total number
projected for Medicaid and CHIP combined under current law. (Under the
bill, CHIP would no longer exist in 2019.) Relative to currently projected
levels, the number of people purchasing individual coverage outside of the
exchanges would decrease by about 6 million, and the number obtaining
coverage through employers would increase by about 6 million.
“Under the proposal, certain employers could allow all of their workers to
choose among the plans available in the exchanges, but those enrollees
would not be eligible to receive subsidies via the exchanges (and thus are
shown in Table 2 as enrollees in employment-based coverage rather than as
exchange enrollees). CBO and JCT expect that approximately 9 million
people would obtain coverage in that way in 2019, bringing the total
number of people enrolled in exchange plans to about 30 million in that
year. Roughly one-fifth of the people purchasing coverage through the
exchanges would enroll in the public plan, meaning that total enrollment in
that plan would be about 6 million.
“That estimate of enrollment reflects CBO’s assessment that a public plan
paying negotiated rates would attract a broad network of providers but
would typically have premiums that are somewhat higher than the average
premiums for the private plans in the exchanges. The rates the public plan
pays to providers would, on average, probably be comparable to the rates
paid by private insurers participating in the exchanges. The public plan
would have lower administrative costs than those private plans but would
probably engage in less management of utilization by its enrollees and
attract a less healthy pool of enrollees. (The effects of that “adverse
selection” on the public plan’s premiums would be only partially offset by
the “risk adjustment” procedures that would apply to all plans operating in
the exchanges.)”
This is a possible scenario. CBO and JCT are about as smart as anyone, and we need a guidepost in all this, Lord knows. But honestly. We know for sure the public plan will have lower administrative costs and no profits. Will it engage in less utilization management (read, frivolous denial of claims) compared to private insurance plans? We hope so – and we damn well plan to stop the insurance industry from that deadly business plan, too. Will it enroll fewer people, therefore be more expensive, therefore enroll sicker people, therefore be more expensive and enroll fewer people, etc.? Beats me.
Here’s what I’m pretty sure about. I don’t like Options #1 and #2. The public doesn’t either.
I think Option #3 gets us to the next step: coming out of this battle with a victory, and going back to the states to fight for single payer.
Some on the left meet up with the right on this point: they prefer Options #1 and #2. They say the House bill (Option #3) gives more money and power to the insurance industry than they have now. True. But so do Options #1 and #2. In fact, the only way the insurance industry gets less money is to get rid of them. A single payer program funded entirely by the government would accomplish this. We haven’t won the public’s support for that yet, and it’s not just because Max Baucus wouldn’t hold hearings on it.
A bill with Option #3 gives more power to the public sector, and arguably will save some money. It includes the following important benefits for people:
For the first time, most employers will have to contribute to the cost of health insurance. We’re the only system in the world that relies primarily on the workplace to get insurance, but we also have no requirement on employers to actually offer insurance or help pay for it. Right now about 130 million people get insurance through work, but another 27 million workers do not.
It requires individuals to buy insurance, but it provides subsidies to low- and middle-income individuals and families, so they can afford it. Is it affordable enough? Probably something to fight about.
Insurance company abuses will be prohibited: They won’t be able to exclude people with pre-existing conditions, or stop paying for your treatment once it turns out your sick. They’ll have to spend 85% of our premium dollars on actual health care, not executive bonuses and administration.
Costs: gives the government the authority to negotiate for drug prices.
Access: Many more people will qualify for Medicaid, the federal-state program for low-income people. The feds pick up most of the tab. People with COBRA can keep it until the new exchanges kick in, in 2013, and young people can stay on their parents’ plans til age 27. We still need it to start sooner.
Quality: Reform Medicare to encourage better quality of care, eliminate copayments for preventive care, and increase the number of primary care providers.
Is any old thing ok then? I think the victories so far on the public plan are important. We have to fight hard to keep it and strengthen it on the House side, and make sure it gets into the Senate bill in conference. And let’s hold on to each others’ email addresses. We’ll need them for the state single payer fights.
Wednesday, October 28, 2009
State single payer amendment pulled from House bill
Rep. Kucinich has announced that his amendment granting an ERISA waiver to single payer states will not be included in the health reform bill that Speaker Nancy Pelosi plans to introduce in the House, probably later this week. The amendment was passed in Committee. It has been a focus of support by progressives, and opposition by the corporate health care industry.
There will be a manager's amendment offered just before the vote on the floor of the House, next week or later.
Who could add the state single payer amendment back into the manager's amendment?
Speaker Nancy Pelosi (202) 225-0100 http://speaker.house.gov/contact/
Rep. Henry Waxman (202) 225-3976 http://waxman.house.gov/Contact/
Rep. George Miller (202) 225-2095 http://georgemiller.house.gov/contactus/2007/08/post_1.html
There will be a manager's amendment offered just before the vote on the floor of the House, next week or later.
Who could add the state single payer amendment back into the manager's amendment?
Speaker Nancy Pelosi (202) 225-0100 http://speaker.house.gov/contact/
Rep. Henry Waxman (202) 225-3976 http://waxman.house.gov/Contact/
Rep. George Miller (202) 225-2095 http://georgemiller.house.gov/contactus/2007/08/post_1.html
Saturday, October 24, 2009
What Do Progressives Want?
What progressives want is the same thing the President wants: to build power for a majority in Congress and the country that will support our issues, and will perceive us as powerful; and to win the best possible health reform.
So far the President has played a pretty smart game. He kept the insurance industry at bay long enough that even the mainstream pundits are willing to say publicly that the industry has no credibility.
But it’s time to cut the cord.
Progressives need to play a smarter hand.
It’s important to sit in at insurance companies. But here’s the thing: 1. Insurance companies have no shame. They really don’t. 2. Even Republicans were willing to throw them under the train back in February. 3. They don’t vote.
Here are some people who vote: Senators Mary Landrieu, Louisiana; Blanche Lincoln, Arkansas; Joe Lieberman, Connecticut; Evan Bayh, Indiana; Ben Nelson. Nebraska
Take Mary Landrieu. She says she won’t support a public option because it would force the country to go bankrupt.
Now Mary Landrieu is not a stupid person. She knows that the CBO says a strong public option saves more money than negotiated rates or no public option.
She’s been elected twice in a Republican state, including in 2008 when Obama got only 40% of the vote.
Is she in the pocket of the insurance industry? The Center for Responsive Politics says she gets virtually no money from health interests, and raises half her money in-state. She’s the 47th least wealthy person in the Senate.
Does Louisiana need health reform? Here’s some information about Louisiana:
Second highest rate of female poverty in the US
Highest rate of black poverty
63% white
4th highest rate of uninsured for ages 0–64 (22%), 3rd highest for ages 19-64
One of the highest recipients in the country of federal Medicaid funds, one of the lowest in per capita Medicaid spending
35% of population live in primary care shortage area, 3rd highest % of population who didn’t see a doctor in the last year because of cost (18%)
In 2008 Obama lost to McCain, but Landrieu won among the same demographics that voted for Obama:
Women
Younger people
African Americans
Among the 9% of voters who said health care was their most important issue, Landrieu got the widest issue-based margin over her opponent: 72% voted for her.
Why can’t a populist organizing campaign rile up some voters in New Orleans and environs to communicate with Senator Landrieu? And in Arkansas, Connecticut, Indiana and Nebraska; and the holdouts in the House. Harry Reid and Nancy Pelosi have signalled they're ready to play. Are we paying attention?
So far the President has played a pretty smart game. He kept the insurance industry at bay long enough that even the mainstream pundits are willing to say publicly that the industry has no credibility.
But it’s time to cut the cord.
Progressives need to play a smarter hand.
It’s important to sit in at insurance companies. But here’s the thing: 1. Insurance companies have no shame. They really don’t. 2. Even Republicans were willing to throw them under the train back in February. 3. They don’t vote.
Here are some people who vote: Senators Mary Landrieu, Louisiana; Blanche Lincoln, Arkansas; Joe Lieberman, Connecticut; Evan Bayh, Indiana; Ben Nelson. Nebraska
Take Mary Landrieu. She says she won’t support a public option because it would force the country to go bankrupt.
Now Mary Landrieu is not a stupid person. She knows that the CBO says a strong public option saves more money than negotiated rates or no public option.
She’s been elected twice in a Republican state, including in 2008 when Obama got only 40% of the vote.
Is she in the pocket of the insurance industry? The Center for Responsive Politics says she gets virtually no money from health interests, and raises half her money in-state. She’s the 47th least wealthy person in the Senate.
Does Louisiana need health reform? Here’s some information about Louisiana:
Second highest rate of female poverty in the US
Highest rate of black poverty
63% white
4th highest rate of uninsured for ages 0–64 (22%), 3rd highest for ages 19-64
One of the highest recipients in the country of federal Medicaid funds, one of the lowest in per capita Medicaid spending
35% of population live in primary care shortage area, 3rd highest % of population who didn’t see a doctor in the last year because of cost (18%)
In 2008 Obama lost to McCain, but Landrieu won among the same demographics that voted for Obama:
Women
Younger people
African Americans
Among the 9% of voters who said health care was their most important issue, Landrieu got the widest issue-based margin over her opponent: 72% voted for her.
Why can’t a populist organizing campaign rile up some voters in New Orleans and environs to communicate with Senator Landrieu? And in Arkansas, Connecticut, Indiana and Nebraska; and the holdouts in the House. Harry Reid and Nancy Pelosi have signalled they're ready to play. Are we paying attention?
Saturday, October 17, 2009
No Excuse for Apathy
Eva Chrysanthe is my health care hero.
Back in January Senator Dianne Feinstein's staff were telling us she wasn't sure about her position on the public option because she was hearing a lot of opposition from people calling in from southern California opposing it. They seemed to be responding to talk radio shows.
A lot of people wrote articles about Dianne Feinstein's campaign contributions. She kept talking about what she was hearing from voters.
Eva networked with people inside Organizing for America and found 1200 people in the Bay Area who thought Dianne should represent us. They demonstrated, set up meetings, flooded her office with letters, petitions and emails. Dianne finally wrote a very long treatise on health reform, indicating that she was open to a public option; or maybe not. She heard about it from the voters.
Last week, Senator Feinstein was one of 30 senators to sign Sherrod Brown's statement supporting a public option. Period. Eva brought the staff a carrot cake.
Let's not get googly eyed about what we can accomplish. We're talking about a political system trying to manage an economy in deep crisis. The President, a charismatic figure who is well-informed about the health care issue on both the policy and personal levels, campaigned on expanding coverage for children.
But lookit, they're going to pass something here. How come no one knows that the public option as written doesn't start til 2013 and won't be open to most of us until years later, if ever? Are we expecting the media to do this job? The corporate owned media exist to manipulate our emotions between commercials so that we will feel sufficiently inadequate or bored to want to buy whatever the sponsors are selling, and definitely sufficiently cynical, apathetic and confused that we will not consider taking political action.
Some progressives also seem generally to think that dismissing and ridiculing the emerging proposal passes for analysis and agitation. Willingness to consider how we might influence the bill to set the stage for future progress has been compared to compromising on slavery (a great analogy, really - all they had to do in that case was stamp their feet and reframe the struggle as a fight for human rights, and by golly that was that).
Expanding Medicare to cover more people would've been a great thing to do. Max Baucus thought so. He proposed it in a Finance Committee document in January. It wasn't single payer for all, just for people over 55. Wimp. Must be due to his campaign contributions. Wonder how Baucus, the present obstacle to the public option, and the 4th poorest member of the Senate, stacks up against Sen. Rockefeller, the 4th richest:
Baucus
Cycle Source of Funds, 2009-2010, Campaign Cmte only
Individual Contributions $5,989,921 52%
PAC Contributions $4,872,291 42%
Candidate self-financing $0 0%
Other $640,654 6%
Rockefeller
Cycle Source of Funds, 2005-2010, Campaign Cmte only
Individual Contributions $3,756,635 63%
PAC Contributions $1,963,331 33%
Candidate self-financing $0 0%
Other $260,341 4%
Cycle Top vote-getting candidates Election Results
2008 Max Baucus* Amount Raised $11,602,479 Amount Spent:$9,305,359 Reelected
Bob Kelleher $0 $0
2002 Max Baucus* Amount Raised: $6,719,728 Amount Spent: $6,795,547 Reelected
Michael A. Taylor Amount Raised: Amount Spent: $1,839,020 $1,839,020
Cycle Top vote-getting candidates Election Results
2008 Jay Rockefeller* Amount Raised: $5,972,208 Amount Spent: $5,979,250 Reelected
Jay Wolfe Amount Raised: $123,862 Amount Spent:$123,720
2002 Jay Rockefeller* Amount Raised: $3,045,338 Amount Spent:$2,889,425 Reelected
Amount Raised: Jay Wolfe $136,373 Amount Spent:$136,373
Turns out they both raise most of their money out of state (Baucus 90%, Rockefeller 75%), virtually no one runs against them, and they spend most of what they raise to get re-elected. Why do they take different positions on the public option? Interesting question. In casting his vote, Baucus said that the public plan had a lot to recommend it, but it was his job to get the bill out of Committee. Sound like he's been getting calls from the White House?
It's great that people are sitting in at insurance companies. For the 3% of Americans who still thought health insurance companies had any legitimacy, aside from employees of the industry and their friends and relatives, it's probably a revelation. For the rest of us, a worthwhile way to spend time this week will be strongly suggesting to our friend in the White House, and our leaders in Congress, that they must cough up a program that is going to benefit people pretty quickly or else people will notice.
We need a strong public plan, that bases reimbursement on Medicare rates and uses Medicare providers so that it's affordable and viable. It should be a choice for each of us, in 2010. And we need an ERISA waiver for single payer states, so that they can convert to single payer without a lawsuit. For example people could cut and paste the following:
LETTER TO THE PRESIDENT, Senate Majority Leader Harry Reid, House Speaker Nancy Pelosi:
The Senate Finance Committee drama has concluded. The American public will not long remember whether or not any Republican voted for health reform. We do want to know if we'll get more affordable, reliable health care coverage, that provides relief soon. It's time to tell the President, House Speaker Pelosi and Senate Majority Leader Reid:
We need a public plan option with affordable premiums, that pays hospitals and doctors Medicare rates +5% and includes Medicare providers - and all of us want to have that choice in 2010! Put that up for a vote and we'll support you!
And the bill must include the state single payer option, proposed by Rep. Dennis Kucinich.
http://www.whitehouse.gov/CONTACT/
http://speaker.house.gov/contact/
http://reid.senate.gov/contact/index.cfm
Back in January Senator Dianne Feinstein's staff were telling us she wasn't sure about her position on the public option because she was hearing a lot of opposition from people calling in from southern California opposing it. They seemed to be responding to talk radio shows.
A lot of people wrote articles about Dianne Feinstein's campaign contributions. She kept talking about what she was hearing from voters.
Eva networked with people inside Organizing for America and found 1200 people in the Bay Area who thought Dianne should represent us. They demonstrated, set up meetings, flooded her office with letters, petitions and emails. Dianne finally wrote a very long treatise on health reform, indicating that she was open to a public option; or maybe not. She heard about it from the voters.
Last week, Senator Feinstein was one of 30 senators to sign Sherrod Brown's statement supporting a public option. Period. Eva brought the staff a carrot cake.
Let's not get googly eyed about what we can accomplish. We're talking about a political system trying to manage an economy in deep crisis. The President, a charismatic figure who is well-informed about the health care issue on both the policy and personal levels, campaigned on expanding coverage for children.
But lookit, they're going to pass something here. How come no one knows that the public option as written doesn't start til 2013 and won't be open to most of us until years later, if ever? Are we expecting the media to do this job? The corporate owned media exist to manipulate our emotions between commercials so that we will feel sufficiently inadequate or bored to want to buy whatever the sponsors are selling, and definitely sufficiently cynical, apathetic and confused that we will not consider taking political action.
Some progressives also seem generally to think that dismissing and ridiculing the emerging proposal passes for analysis and agitation. Willingness to consider how we might influence the bill to set the stage for future progress has been compared to compromising on slavery (a great analogy, really - all they had to do in that case was stamp their feet and reframe the struggle as a fight for human rights, and by golly that was that).
Expanding Medicare to cover more people would've been a great thing to do. Max Baucus thought so. He proposed it in a Finance Committee document in January. It wasn't single payer for all, just for people over 55. Wimp. Must be due to his campaign contributions. Wonder how Baucus, the present obstacle to the public option, and the 4th poorest member of the Senate, stacks up against Sen. Rockefeller, the 4th richest:
Baucus
Cycle Source of Funds, 2009-2010, Campaign Cmte only
Individual Contributions $5,989,921 52%
PAC Contributions $4,872,291 42%
Candidate self-financing $0 0%
Other $640,654 6%
Rockefeller
Cycle Source of Funds, 2005-2010, Campaign Cmte only
Individual Contributions $3,756,635 63%
PAC Contributions $1,963,331 33%
Candidate self-financing $0 0%
Other $260,341 4%
Cycle Top vote-getting candidates Election Results
2008 Max Baucus* Amount Raised $11,602,479 Amount Spent:$9,305,359 Reelected
Bob Kelleher $0 $0
2002 Max Baucus* Amount Raised: $6,719,728 Amount Spent: $6,795,547 Reelected
Michael A. Taylor Amount Raised: Amount Spent: $1,839,020 $1,839,020
Cycle Top vote-getting candidates Election Results
2008 Jay Rockefeller* Amount Raised: $5,972,208 Amount Spent: $5,979,250 Reelected
Jay Wolfe Amount Raised: $123,862 Amount Spent:$123,720
2002 Jay Rockefeller* Amount Raised: $3,045,338 Amount Spent:$2,889,425 Reelected
Amount Raised: Jay Wolfe $136,373 Amount Spent:$136,373
Turns out they both raise most of their money out of state (Baucus 90%, Rockefeller 75%), virtually no one runs against them, and they spend most of what they raise to get re-elected. Why do they take different positions on the public option? Interesting question. In casting his vote, Baucus said that the public plan had a lot to recommend it, but it was his job to get the bill out of Committee. Sound like he's been getting calls from the White House?
It's great that people are sitting in at insurance companies. For the 3% of Americans who still thought health insurance companies had any legitimacy, aside from employees of the industry and their friends and relatives, it's probably a revelation. For the rest of us, a worthwhile way to spend time this week will be strongly suggesting to our friend in the White House, and our leaders in Congress, that they must cough up a program that is going to benefit people pretty quickly or else people will notice.
We need a strong public plan, that bases reimbursement on Medicare rates and uses Medicare providers so that it's affordable and viable. It should be a choice for each of us, in 2010. And we need an ERISA waiver for single payer states, so that they can convert to single payer without a lawsuit. For example people could cut and paste the following:
LETTER TO THE PRESIDENT, Senate Majority Leader Harry Reid, House Speaker Nancy Pelosi:
The Senate Finance Committee drama has concluded. The American public will not long remember whether or not any Republican voted for health reform. We do want to know if we'll get more affordable, reliable health care coverage, that provides relief soon. It's time to tell the President, House Speaker Pelosi and Senate Majority Leader Reid:
We need a public plan option with affordable premiums, that pays hospitals and doctors Medicare rates +5% and includes Medicare providers - and all of us want to have that choice in 2010! Put that up for a vote and we'll support you!
And the bill must include the state single payer option, proposed by Rep. Dennis Kucinich.
http://www.whitehouse.gov/CONTACT/
http://speaker.house.gov/contact/
http://reid.senate.gov/contact/index.cfm
Thursday, October 8, 2009
CBO should score systemwide savings from health reform
Supporters of comprehensive, single payer health reform are looking forward to a report from the Congressional Budget Office on how much ths kind of system would cost. But in 1993, when I worked with Senator Wellstone on his S.491, the original national single payer bill, CBO's "score" was dramatic and groundbreaking for showing how much the system would save:
http://www.cbo.gov/ftpdocs/79xx/doc7946/93doc07b.pdf
By definition any single payer system contributes to federal spending: the feds pick up the tab for all health care expenses. The important part is the escalating savings from single payer - more and more, the longer the system is in place. In its 1993 report, the CBO illustrated that the single payer system not only slows the rate of growth in health spending - what the President calls "bending the cost curve" - it saved more every year from total national health expenditures: a reduction of $67 billion in 2002, $110 billion in 2003.
Look at this:
TABLE 2. PROJECTIONS OF NATIONAL HEALTH EXPENDITURES,
(By calendar year, in billions of dollars)
1997 1998 1999 2000 2001 2002 2003
Baseline
Total 1,163 1,263 1,372 1,488 1,613 1,748 1,894 2,052
Changes from Baseline (effects of the single payer bill)
Total a 60 59 35 4 (minus 29) (minus 67) -110
SOURCE: Congressional Budget Office,
a. Less than $500 million.
Now the CBO seems to be saying it will calculate only the cost to the federal government, sending the bill sponsors on the House side into exercises to cut promised benefits and alter other provisions to reduce the impact on the federal deficit. CBO should go back to answering the full range of critical questions for the American public, most notably: How much is this going to cost me? The answer is that single payer would save a ton.
http://www.cbo.gov/ftpdocs/79xx/doc7946/93doc07b.pdf
By definition any single payer system contributes to federal spending: the feds pick up the tab for all health care expenses. The important part is the escalating savings from single payer - more and more, the longer the system is in place. In its 1993 report, the CBO illustrated that the single payer system not only slows the rate of growth in health spending - what the President calls "bending the cost curve" - it saved more every year from total national health expenditures: a reduction of $67 billion in 2002, $110 billion in 2003.
Look at this:
TABLE 2. PROJECTIONS OF NATIONAL HEALTH EXPENDITURES,
(By calendar year, in billions of dollars)
1997 1998 1999 2000 2001 2002 2003
Baseline
Total 1,163 1,263 1,372 1,488 1,613 1,748 1,894 2,052
Changes from Baseline (effects of the single payer bill)
Total a 60 59 35 4 (minus 29) (minus 67) -110
SOURCE: Congressional Budget Office,
a. Less than $500 million.
Now the CBO seems to be saying it will calculate only the cost to the federal government, sending the bill sponsors on the House side into exercises to cut promised benefits and alter other provisions to reduce the impact on the federal deficit. CBO should go back to answering the full range of critical questions for the American public, most notably: How much is this going to cost me? The answer is that single payer would save a ton.
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